Father Time and Baby New Year (Not Necessarily in That Order)

EDITORIAL

Neal Flomenbaum, MD EDITOR-IN-CHIEF

or most of us, December is the PEM fellows would come from fragment EM? I believe the an- a month of frenzied holiday each of the two primary special- swers to the last two questions are activities followed by a time ties. It didn’t exactly work out that yes, and no. Fto reflect on the year that is way, and today over 90% of fellow- Patients in their late 70s and be- ending and the new one about to ship-trained, board-certified PEM yond differ in many respects from begin. The old and new years are physicians initially train in pedi- children and younger adults by frequently depicted by an aged and atric residencies. One concern ex- their diminished reserve to handle stooped Father Time carrying a pressed by many EPs then and ever acute traumatic and nontraumatic scythe and an hourglass, accompa- since is that a subspecialty in PEM emergencies, their comorbidities, nied by an energetic Baby New Year would split off emergency care of their responses to medications and, in diapers. This season, I find my- children from EM, leaving EPs perhaps most dramatically, by the self thinking about how emergency even less prepared to deal with pe- different ways their acute illnesses medicine is dealing with patients at diatric emergencies in the absence present—suggesting possible med- both extremes of life. of a discrete pediatric ED and/or ical treatments for some causes of When EM was first recognized a PEM physician. This, in fact, is acute confusion. as a distinct medical specialty in a reality in many urban academic But GEM training need not carve 1979, one might have assumed that tertiary care centers, particularly out another piece of the EM pie. Ev- it would encompass patients of all those with nearby children’s hospi- ery properly trained EP should be ages, and to a large extent it still tals. But in most other settings the able to expertly care for the elderly, does. Yet, only a decade after EM need for trained and qualified EPs while those who have a special in- itself became a specialty, pediatric to expertly manage pediatric emer- terest in the clinical, educational, or emergency medicine was recog- gencies is no less now than it was research issues of GEM should have nized as a subspecialty of both EM before PEM was created. Neverthe- an opportunity to pursue them. and pediatrics. At that time, many less, concerns about slicing the EM This might ideally be accomplished pediatricians didn’t think they pie also continue. in a 2-year GEM fellowship culmi- needed any additional training in In this setting, enter Father Time nating in an MPH degree. EM to manage childhood emergen- with his hourglass and a rapidly in- With the passage of time, con- cies, while many EPs didn’t think creasing group of friends. Dare any- ditions change. PEM became im- they needed any additional pediat- one think of additional training in portant in 1991, GEM makes sense ric training. geriatric emergency medicine? Are now. EM should not be timid about The EM and pediatric boards the needs of this segment of the redefining or reinventing itself as (ABEM and AAP), however, were population so different than those needed. After all, EM owes its own more enthusiastic about such fel- of other adult patients? And if so, creation to needs unmet by older lowship training, and the common will additional training to manage established specialties 40 years ago. belief then was that about half of the other extreme of age further Happy New Year! EM